Provider Demographics
NPI:1467424408
Name:HAAS, WILLIAM ADOLF (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:ADOLF
Last Name:HAAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4211 VAN DYKE RD STE 101B
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33558-8005
Mailing Address - Country:US
Mailing Address - Phone:813-960-4026
Mailing Address - Fax:813-443-8166
Practice Address - Street 1:4211 VANDYKE ROAD
Practice Address - Street 2:SUITE 101B
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33558-8005
Practice Address - Country:US
Practice Address - Phone:813-960-4026
Practice Address - Fax:813-960-4489
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME78965207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL257253200Medicaid
G95874Medicare UPIN
FL49129XMedicare PIN
FLP01040247Medicare PIN
FL0471260006Medicare NSC